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Kidney Week

Abstract: PO1949

A Case of Asymptomatic Juxtaglomerular Cell Tumor (JGCT)

Session Information

Category: Pathology and Lab Medicine

  • 1600 Pathology and Lab Medicine

Authors

  • Garg, Arvind K., Mayo Clinic Health System, La Crosse, Wisconsin, United States
  • Androga, Lagu A., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Introduction

JGCT/ reninoma is an extremely rare benign neoplasm of kidneys typically manifesting as hypertension and hypokalemia secondary to renin secreting tumor cells. We present a case of JGCT presenting as an asymptomatic renal mass.

Case Description

A 61-year-old male of with diabetes mellitus, hypertension (>15 years duration, well-controlled with Losartan 100mg daily) presented with right upper quadrant abdominal pain. Computed tomography scan of abdomen /pelvis with intravenous contrast revealed cholelithiasis without cholecystitis and an incidental 3cm mass at the mid-pole of the left kidney without renal vascular involvement. Kidney ultrasound 5 years prior did not show any renal mass. Spot urinalysis showed no hematuria and proteinuria was 96 mg/g (normal < 150 mg/g). Baseline serum creatinine was 1.3-1.4 mg/dl (normal 0.7-1.3 mg/dl). 24-hour urine creatinine clearance was normal. Given the high suspicion for a malignancy, the patient underwent recommended left radical nephrectomy. Kidney mass biopsy diagnosed JGCT. Light microscopy showed well circumscribed tumor with glomoid appearance with sheets of uniform round- to-polygonal cell with clear to eosinophilic cytoplasm. In addition, there were focal endocrine-like, markedly atypical hyperchromatic nuclei occasionally scattered throughout the tumor. Immunohistochemical stains demonstrated diffuse positivity in tumor cells for CD34 (Figure 1), CD117 and vimentin (Figure 2). Patient sustained a slight rise in creatinine post nephrectomy as expected and he continued to require only one anti-hypertensive medication. Patient remained in remission with stable kidney function without recurrence of tumor at 2 years follow-up.

Discussion

JGCT can present as hypertension and hypokalemia. Our patient had optimal blood pressure control on monotherapy. Losartan may have masked the associated hypokalemia. Nephrectomy (partial or radical) is curative and is the recommended treatment.

CD 34 stain and vimentin stain kidney mass pathology images